Consumer assessments of health care are increasingly being used as an indicator of the quality of care provided by health plans and providers, while consumer ratings of health care can provide important information about how health plans and clinicians meet people's needs. The extent to which the former varies by race/ethnicity is important in evaluating health plan performance. Differences in sub-group evaluations may be due to response bias or to differences in the quality of care. The proposed study will examine the racial-ethnic differences in consumer health plan assessments for adults and children enrolled in managed care plans. The three research questions are: (1) Do the psychometric properties of the consumer reports and ratings of health plans differ by race/ethnicity?; (2) Do consumer reports and ratings of health plans vary by race/ethnicity; and (3) Do managed care organizational characteristics (OCs) account for the observed racial-ethnic differences in reports and ratings of health care? Data are from the National CAHPS(R) Benchmarking Database (NCBD) (169,136 commercial adults, 28,420 Medicaid adults, 42,879 commercial children [< 18 years], and 14,016 Medicaid children [ < 18 years]). The sample consists of consumers in 599 health plans in 39 states, DC, Guam, and Puerto Rico for 1998-1999. The 1999 NCQA Quality Compass database will be used to identify health plan OCs. The dependent variables are CAHPS(R) 2.0 ratings and reports of care, and the independent variables include race/ethnicity, case mix variables (gender, age, education, health status), and health plan characteristics. Equivalence of CAHPS(R) items and composites across race-ethnic subgroups will be compared using reliability estimates, confirmatory factor analysis, and item response theory analysis. Regression methods will be used to evaluate the associations of race/ethnicity with CAHPS(R) reports and care ratings and to examine whether managed care OCs account for observed racial-ethnic differences in health care reports and ratings.